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Saturday, December 10, 2011

Morton's Neuromas: Email Advice

Dear Dr. Blake,
My name is Cyndi. I am a physician assistant in NY. I have bilateral morton's neuromas (MNs). I stumbled upon your blog while looking for treatment options. I am VERY impressed with your knowledge and experience.
 
I use to be a runner, until I developed these interesting things 18 months ago. I had been going to a podiatrist on/off for over 20 years for orthotics for early bunions. I went to him when I developed MNs. He tried cortisone shots (I've done 3 each foot- not sure of dosage), with some relief. But about a month ago, I started wearing my running shoes (asics) and my orthotics again, and now my MNs are screaming! Feels like a knuckle pushing hard between #2 and 3. I can only wear Crocs shoes. Everything else seems to irritate. Also my orthotics really exacerbate the problem.
 
My mother also has them, worse than me, and she tried cortisone shots, alcohol shots, and then some odd shock wave thing??? Nothing has helped her.
 
So my question is, do you know of a great podiatrist in NY area that is really good at managing the MNs?  Since I wont be taking any trips to San Fran anytime soon, I was hoping you could give me a referral.
 
Thanks so much for you blog and your time.
Cyndi

Response from Dr Blake: 
     Thanks so much for the advice. New York has a plethora (just wanted to use this word) of great podiatrists who practice sports medicine. The ones I send people to routinely (in no particular order) are Robert Conenello (Orangeburg), Karen Langone (SouthHampton), David Davidson(Amherst), and Susanne Solomon (Ithaca). You can get their addresses through the member listing for the American Academy of Podiatric Sports Medicine (www.aapsm.org). Please use my name as a referral. If none are near, ask to speak to them to get a more local referral. They would know who was good in your area. 
     If Crocs feels great, some New York version of the Hannaford orthotic mentioned in my blog will probably help. When the nerves are really inflamed, they normally don't like the pressure from most orthotics, inserts, arch supports. You may need a more direct off loading with accommodative padding to ease the acute pain. Ice three or 4 times daily for 5 minutes. If it feels great temporarily, increase the time to 10 minutes. 
     The blog also mentions looking at the nerve as part of your whole body. This is especially true when it is on both sides. You must rule out peripheral neuropathy or low back involvement. You can have inflamed nerves in your feet, but they only really hurt because they are supercharged from the budging disc in the low back, or one of the 100 causes of peripheral neuropathy. 
     If 2 weeks have passed from the last shots, an MRI of both forefoot with the rationale of looking for a possible surgical problem should be done. I can drag patients through conservative treatment only to find out that they do great with surgery. But, I would try to avoid surgery for at least 1 year from the start of treatment, my personal mantra. You never know what you may discover will work. Do they have acupuncture in New York? It is big here in San Francisco, and very helpful at times for Morton's Neuromas. 
     I hope this helps my friend from New York. Good luck. Rich Blake

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.